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2.
Dent Med Probl ; 60(2): 335-344, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36441158

RESUMEN

The aim of the study was to evaluate the methodological quality and the risk of bias of systematic reviews with regard to the literature on therapies for sleep bruxism (SB) in dentistry, applying the AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews) qualitative guide, as well as the effectiveness of various kinds of treatment of SB. Initially, a total of 1,499 articles were obtained from 4 databases and 2 websites. Relevant articles were obtained from the PubMed, Scopus, Cochrane, and Embase databases as well as from Google Scholar and OpenGrey. Six systematic reviews that met the eligibility criteria were included. The methodological quality of all systematic reviews, assessed with the AMSTAR 2 tool, was critically low. Regarding treatment effectiveness, 5 systematic reviews reported on pharmacological management (botulinum toxin type A (BTX-A), clonazepam and clonidine), 2 reported on oral appliances (OAs) (stabilizing splints and mandibular advancement devices (MADs)) and 1 study addressed the effects of biofeedback (BF). The results of the therapies were diverse and confusing. The available research is not conclusive, and does not show clear evidence or a consensus on the part of researchers on the most effective treatment for the management of SB. More research of better methodological quality is needed in this area.


Asunto(s)
Bruxismo del Sueño , Humanos , Bruxismo del Sueño/tratamiento farmacológico , Revisiones Sistemáticas como Asunto , Clonazepam/uso terapéutico , Resultado del Tratamiento , Odontología
3.
Int. j interdiscip. dent. (Print) ; 15(1): 101-108, abr. 2022. tab
Artículo en Español | LILACS | ID: biblio-1385238

RESUMEN

RESUMEN: Introducción: El bruxismo del sueño es un comportamiento que se caracteriza por la actividad repetitiva de los músculos masticadores. Varias terapias para el manejo del bruxismo del sueño se centran en la relajación de los músculos involucrados, incluyendo la inyección intramuscular de Toxina Botulínica tipo A (BoNTA). A pesar de que se ha comprobado la efectividad de esta terapia frente al dolor subjetivo, cuando se asocia a bruxismo del sueño, es necesario determinarla frente a desenlaces objetivos, tanto a nivel craneofacial como sistémico. Además, se debe evaluar también la seguridad de esta intervención frente a eventos adversos tales como afecciones estéticas, debilidad masticatoria y pérdida ósea mandibular, entre otros. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un meta-análisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos 11 revisiones sistemáticas que en conjunto incluyeron 9 estudios primarios, de los cuales, 8 corresponden a ensayos aleatorizados. Concluimos que la inyección intramuscular de toxina botulínica tipo A podría disminuir el dolor en reposo, presentar poca o nula diferencia en dolor durante la masticación y mejorar la autoevaluación del bruxismo, pero la certeza de la evidencia es baja. Por otra parte, no es posible establecer con claridad si el uso de Toxina Botulínica Tipo A disminuye el número de eventos de bruxismo, ya que la certeza de la evidencia ha sido evaluada como muy baja. Finalmente y a pesar de la evidencia existente respecto de los potenciales eventos adversos producto de la intervención con Toxina Botulínica Tipo A en los músculos masticatorios, los ensayos clínicos fallan en evaluarlos y reportarlos.


ABSTRACT: Introduction: The sleep bruxism is a behavior that impacts the craniofacial musculoskeletal system characterized by repetitive activity of the masticatory muscles. Several management strategies for sleep bruxism are focused of the relaxation of the involved masticatory muscles, including the intramuscular injection of botulinum toxin type A (BoNTA). Although the effectiveness of BoNTA for myofascial pain, when related with the sleep bruxism in adult patients, it is necessary to determine its effectiveness using objective outcomes at both craniofacial and systemic levels. In addition, it is necessary to determine the safety of this intervention in the context of adverse events such as aesthetic alterations, reduced masticatory function, mandibular bone loss among others. Methods: A search was performed using Epistemonikos, the biggest database for systematic reviews in health, with is maintained by screening of multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. Data from systematic reviews were extracted, and analysis of the primary studies was performed, including a meta-analysis and a summary of findings table using GRADE assessment. Results and conclusions: 11 systematic reviews were identified, and 9 primary studies were included. 8 out of these 9 studies corresponded to randomized clinical trials. We conclude that the intramuscular injection of BoNTA may reduce the pain during rest and results in either little or none difference in pain during mastication, when pain is associated with sleep bruxism in adult patients. Also, low evidence is determined for auto-report and subjective evaluation of sleep bruxism among adult patients. Additionally, it is not possible to determine if the BoNTA intervention is effective to reduce the bruxism events due to the low evidence. Finally, although evidence regarding adverse events such as mandibular bone loss after BoNTA intervention in masticatory muscles has been published at preclinical and clinical levels, the clinical trials fail to consider and to report these outcomes.


Asunto(s)
Humanos , Adulto , Persona de Mediana Edad , Toxinas Botulínicas Tipo A/uso terapéutico , Bruxismo del Sueño/tratamiento farmacológico
4.
Phytomedicine ; 58: 152869, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30831467

RESUMEN

PURPOSE: The present randomized controlled clinical trial evaluated the efficacy of homeopathic medicines of Melissa officinalis (MO), Phytolacca decandra (PD), and the combination of both in the treatment of possible sleep bruxism (SB) in children. STUDY DESIGN: Patients (n = 52) (6.62 ± 1.79 years old) were selected based on the parents report of SB. The study comprised a crossover design that included 4 phases of 30-day treatment (Placebo; MO 12c; PD 12c; and MO 12c + PD 12c), with a wash-out period of 15 days between treatments. METHODS: At baseline and after each phase, the Visual Analogic Scale (VAS) was used as the primary outcome measure to evaluate the influence of treatments on the reduction of SB. The following additional outcome measures were used: a children's sleep diary with parent's/guardian's perceptions of their children's sleep quality, the trait of anxiety scale (TAS) to identify changes in children's anxiety profile, and side effects reports. Data were analyzed by ANOVA with repeated measures followed by Post Hoc LSD test. RESULTS: Significant reduction of SB was observed in VAS after the use of Placebo (-1.72 ± 0.29), MO (-2.36 ± 0.36), PD (-1.44 ± 0.28) and MO + PD (-2.21 ± 0.30) compared to baseline (4.91 ± 1.87). MO showed better results compared to PD (p = 0.018) and Placebo (p = 0.050), and similar result compared to MO+PD (p = 0.724). The sleep diary results and TAS results were not influenced by any of the treatments. No side effects were observed after treatments. CONCLUSION: MO showed promising results in the treatment of possible sleep bruxism in children, while the association of PD did not improve MO results.


Asunto(s)
Homeopatía , Melissa/química , Phytolacca/química , Extractos Vegetales/farmacología , Bruxismo del Sueño/tratamiento farmacológico , Ansiedad/tratamiento farmacológico , Niño , Preescolar , Estudios Cruzados , Femenino , Humanos , Masculino , Padres , Extractos Vegetales/química , Hojas de la Planta/química , Tallos de la Planta/química , Autoinforme , Sueño
5.
Syst Rev ; 6(1): 4, 2017 01 13.
Artículo en Inglés | MEDLINE | ID: mdl-28086992

RESUMEN

BACKGROUND: Bruxism is a sleep disorder characterized by grinding and clenching of the teeth that may be related to irreversible tooth injuries. It is a prevalent condition occurring in up to 31% of adults. However, there is no definitive answer as to which of the many currently available treatments (including drug therapy, intramuscular injections, physiotherapy, biofeedback, kinesiotherapy, use of intraoral devices, or psychological therapy) is the best for the clinical management of the different manifestations of bruxism. The aim of this systematic review and network meta-analysis is to answer the following question: what is the best treatment for adult bruxists? METHODS/DESIGN: Comprehensive searches of the Cochrane Library, MEDLINE (via PubMed), Scopus, and LILACS will be completed using the following keywords: bruxism and therapies and related entry terms. Studies will be included, according to the eligibility criteria (Controlled Clinical Trials and Randomized Clinical Trials, considering specific outcome measures for bruxism). The reference lists of included studies will be hand searched. Relevant data will be extracted from included studies using a specially designed data extraction sheet. Risk of bias of the included studies will be assessed, and the overall strength of the evidence will be summarized (i.e., GRADE). A random effects model will be used for all pairwise meta-analyses (with a 95% confidence interval). A Bayesian network meta-analysis will explore the relative benefits between the various treatments. The review will be reported using the Preferred Reporting Items for Systematic Reviews incorporating Network Meta-Analyses (PRISMA-NMA) statement. DISCUSSION: This systematic review aims at identifying and evaluating therapies to treat bruxism. This systematic review may lead to several recommendations, for both patients and researchers, as which is the best therapy for a specific patient case and how future studies need to be designed, considering what is available now and what is the reality of the patient. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015023308.


Asunto(s)
Bruxismo del Sueño/terapia , Biorretroalimentación Psicológica/métodos , Terapia Cognitivo-Conductual , Estimulación Eléctrica/métodos , Humanos , Avance Mandibular/métodos , Metaanálisis en Red , Modalidades de Fisioterapia , Terapia por Relajación/métodos , Bruxismo del Sueño/tratamiento farmacológico , Revisiones Sistemáticas como Asunto
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